Marijuana and Cardiac Arrhythmias: A Scoping Study

Abstract

With increasing legalization, marijuana has become the most commonly abused substance in the United States. Together with the introduction of more potent marijuana products over the years, more adverse events are being reported and clinically characterized. Delta-9-tetrahydrocannabinol (THC) is the active psychotropic component of marijuana, which acts mainly on G-protein cannabinoid receptors CB1 and CB2. Multiple isolated cases of arrhythmias associated with marijuana use have been published. In this manuscript we conduct a scoping study of a total of 27 cases of arrhythmia associated with marijuana. Most cases were reported in young males (81%) with a mean age of 28 ± 10.6 years. Atrial fibrillation (26%) and ventricular fibrillation (22%) were the most common arrhythmias reported. Brugada pattern was reported in 19% of the patients. Marijuana associated arrhythmia resulted in a high mortality rate of 11 %. While the exact mechanisms of arrhythmias associated with marijuana are not clear, several hypothesis have been introduced including the effect of marijuana on cardiac ion channels as well as its effects on the central nervous system. In this paper we discuss the possible mechanisms of marijuana induced arrhythmia citing the evidence available to-date.

Myocardial Infarction Secondary to Marijuana-Induced Coronary Vasospasm

“…Coronary Slow Flow Phenomenon (CSFP) is an angiographic finding, where by there is a delay in distal vessel opacification in the absence of a significant occlusion and/or stenosis of the coronary vessel [13]. This underlying innocuous finding has great clinical implications since it has been linked to various effects such as myocardial ischemia, recurrent ACS, arrhythmias, and even sudden cardiac death [14][15][16][17][18]. In addition, CSFP and vasospastic angina share common features, such as both improve symptomatically from chest pain following oral calcium channel blockers (CCB) an oral nitroglycerin [15].…”

Cannabinoid-Induced Brugada Syndrome: A Case Report

“…The usual effects of marijuana on the cardiovascular system consist of dosedependent tachycardia and hypotension, propagated primarily by THC [4]. In addition to this, various cardiac arrhythmias have been well documented, including atrial fibrillation and flutter, ventricular tachycardia and fibrillation, atrioventricular (AV) block, and asystole [5,6]. Current research on cardiac ion channel effects is an emerging area of study.…”

Chronic marijuana consumption leading to reversible high-grade atrioventricular block in young male: A case report

“…Atrial fibrillation (26%) and ventricular fibrillation (22%) were the most common arrhythmias. Brady arrhythmia were not common; first and second degree AV block and sinus arrest (3.7 % each) were the common findings among bradyarrythmia group 14 In another extensive review about the association of cannabis use and cardiac dysrhythmias, out of 42 subjects, third degree AV block was found in 12% of cases while symptomatic bradycardia was present in 10 % of the cases . 15 Table 1 depicts reported cases of severe bradyarrythmia due to marijuana toxicity.…”